Composition for inhibition of cathepsin k

ABSTRACT

The present invention relates to the a method of inhibiting bone resorption in a mammal in need thereof with an oral pharmaceutical composition comprising a cathepsin K inhibitor, or a pharmaceutically acceptable salt thereof, or a mixture thereof, according to a continuous schedule having a dosage interval of once weekly, biweekly, twice monthly or once monthly.

BACKGROUND OF THE INVENTION

A variety of disorders in humans and other mammals involve or areassociated with abnormal bone resorption. Such disorders include, butare not limited to, osteoporosis, glucocorticoid induced osteoporosis,Paget's disease, abnormally increased bone turnover, periodontaldisease, tooth loss, bone fractures, rheumatoid arthritis,osteoarthritis, periprosthetic osteolysis, osteogenesis imperfecta,hypercalcemia of malignancy, multiple myeloma, and metastatic bonedisease. One of the most common of these disorders is osteoporosis,which in its most frequent manifestation occurs in postmenopausal women.Osteoporosis is a systemic skeletal disease characterized by a low bonemass and microarchitectural deterioration of bone tissue, with aconsequent increase in bone fragility and susceptibility to fracture.Osteoporotic fractures are a major cause of morbidity and mortality inthe elderly population. As many as 50% of women and a third of men willexperience an osteoporotic fracture. A large segment of the olderpopulation already has low bone density and a high risk of fractures.There is a significant need to both prevent and treat osteoporosis andother conditions associated with bone resorption. Because osteoporosis,as well as other disorders associated with bone loss, are generallychronic conditions, it is believed that appropriate therapy willtypically require chronic treatment.

Cysteine protease inhibitors such as E-64(trans-epoxysuccinyl-L-leucylamide-(4-guanidino) butane) are known to beeffective in inhibiting bone resorption. See Delaisse, J M et al., 1987,Bone 8:305-313, which is hereby incorporated by reference in itsentirety. Recently, cathepsin K was cloned and found specificallyexpressed in osteoclasts See Tezuka, K et al., 1994, J Biol Chem269:1106-1109; Shi, G P et al., 1995, FEBS Lett 357:129-134; Bromme, Dand Okamoto, K, 1995, Biol Chem Hoppe Seyler 376:379-384; Bromme, D etal., 1996, J Biol Chem 271:2126-2132; Drake, F H et al., 1996, J BiolChem 271:12511-12516, which are hereby incorporated by reference intheir entirety. Concurrent to the cloning, the autosomal recessivedisorder, pycnodysostosis, characterized by an osteopetrotic phenotypewith a decrease in bone resorption, was mapped to mutations present inthe cathepsin K gene. To date, all mutations identified in the cathepsinK gene are known to eliminate collagenase activity. See Gelb, B D etal., 1996, Science 273:1236-1238; Johnson, M R et al., 1996, Genome Res6:1050-1055; Hou, W -S et al., 1999 J. Clin. Invest. 103, 731-738 whichare hereby incorporated by reference in their entirety. Therefore, itappears that cathepsin K is involved in osteoclast mediated boneresorption.

Human type I collagen, the major collagen in bone is a good substratefor cathepsin K. See Kafienah, W, et al., 1998, Biochem J 331:727-732,which is hereby incorporated by reference in its entirety. In vitroexperiments using antisense oligonucleotides to cathepsin K, have showndiminished bone resorption in vitro, which is probably due to areduction in translation of cathepsin K mRNA. See Inui, T, et al., 1997,J Biol Chem 272:8109-8112, which is hereby incorporated by reference inits entirety. The crystal structure of cathepsin K has been resolved.See McGrath, M E, et al., 1997, Nat Struct Biol 4:105-109; Zhao, B, etal., 1997, Nat Struct Biol 4: 109-11, which are hereby incorporated byreference in their entirety. Also, selective peptide based inhibitors ofcathepsin K have been developed See Bromme, D, et al., 1996, Biochem J315:85-89; Thompson, S K, et al., 1997, Proc Natl Acad Sci USA94:14249-14254, which are hereby incorporated by reference in theirentirety. Accordingly, inhibitors of cathepsin K can reduce boneresorption. Such inhibitors would be useful in treating disordersinvolving bone resorption, such as osteoporosis.

Weekly and monthly compositions of a cathpesin K inhibitor would providetherapeutic advantages over other therapies and would enhanceconvenience, patient compliance and patient satisfaction.

SUMMARY OF THE INVENTION

The present invention relates to an oral pharmaceutical compositioncomprising a cathepsin K inhibitor, or a pharmaceutically acceptablesalt thereof, or a mixture thereof, adapted for inhibiting boneresorption according to a continuous schedule having a dosage intervalof once weekly, biweekly, twice monthly or once monthly.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to the use of a cathepsin K inhibitor, ora pharmaceutically acceptable salt thereof, or a mixture thereof, forthe manufacture of a medicament, characterized by a single-dose AUC₀₋₁₆₈of about 2.00-80.0 μM/hr and a C_(min) of about 10 nM to about 200 nM,as an oral unit dose for inhibiting bone resorption in a mammal in needthereof according to a continuous schedule having a dosage interval ofonce weekly, biweekly, twice monthly or once monthly. The presentinvention also relates to a method of inhibiting bone resorption inmammal in need thereof by administering a cathepsin K inhibitor, or asalt thereof, or a mixture thereof, characterized by a single-doseAUC₀₋₁₆₈ of about 2.00-80.0 μM/hr and a C_(min) of about 10 nM to about200 nM, in an oral unit dose according to a continuous schedule having adosage interval of once weekly, biweekly, twice monthly or once monthly.

In an embodiment of the invention, the mammal, specifically a human, isidentified as suffering from or susceptible to upper gastrointestinaldisorders. In a class of the embodiment, the upper gastrointestinaldisorder is gastrointestinal reflux disease (GERD), esophagitis,dyspepsia (heartburn) or ulcers.

In an embodiment of the invention, the present invention relates to theuse of about 2.5 mg to about 250 mg of a cathepsin K inhibitor accordingto Formula I:

wherein R¹ is C₁₋₃ alkyl which is substituted with two to seven halo;R² is hydrogen or halo;

X is N or CH;

D is aryl or heteroaryl, wherein each said aryl or heteroaryl group,which may be monocyclic or bicyclic, is optionally substituted on eitherthe carbon or the heteroatom with one to four substituents independentlyselected from methyl, C₁₋₆ haloalkyl, halo or —SO₂R⁴;R³ is hydrogen, C₁₋₆ alkyl, C₂₋₆ alkynyl, halo, cyano, aryl, heteroaryl,C₃₋₈ cycloalkyl, heterocyclyl, —OR⁴, —C(O)N(R⁵)(R⁶), —C(R⁵)(R⁶)OH,—C(R⁵)(R⁶)N(R⁴)₂, —SO_(m)R⁴, —SO₂N(R⁴)(R⁵), or —SO₂N(R⁵)C(O)(R⁷);wherein said alkyl, alkynyl, aryl, heteroaryl, cycloalkyl andheterocyclyl groups are optionally substituted on either the carbon orthe heteroatom with one to five substituents independently selected fromC₁₋₆ alkyl or halo;R⁴ is hydrogen, C₁₋₆ alkyl, aryl, aryl(C₁₋₄)alkyl, heteroaryl,heteroaryl(C₁₋₄)alkyl, C₃₋₈ cycloalkyl,C₃₋₈ cycloalkyl(C₁₋₄)alkyl, or heterocyclyl(C₁₋₄)alkyl; which areoptionally substituted with one, two, or three substituentsindependently selected from halo, alkoxy or —SO₂R⁷;R⁵ is hydrogen, C₁₋₆ alkyl, or C₁₋₆ haloalkyl;R⁶ is hydrogen, C₁₋₆ alkyl, or C₁₋₆ haloalkyl;Or R⁵ and R⁶ can be taken together with the carbon or nitrogen atombetween them to form a 3 to 6 membered ring;R⁷ is hydrogen or C₁₋₆ alkyl which is optionally substituted with one,two, or three substituents independently selected from halo or cyano;m is an integer from zero to two;or a salt, stereoisomer, N-oxide derivative, or a mixture thereof, forthe manufacture of a medicament as an oral unit dose for inhibiting boneresorption in a mammal in need thereof according to a continuousschedule having a dosage interval of once weekly, biweekly, twicemonthly or once monthly.

In an embodiment of the invention, the present invention relates to theuse of about 2.5 mg to about 250 mg of a cathepsin K inhibitor accordingto Formula II:

wherein R¹ is halo;R² is halo;R³ is hydrogen, C₁₋₆ alkyl, C₁₋₆ haloalkyl, C₃₋₆ cycloalkyl, aryl orheteroaryl;or a salt, stereoisomer, N-oxide derivative, or a mixture thereof, forthe manufacture of a medicament as an oral unit dose for inhibiting boneresorption in a mammal in need thereof according to a continuousschedule having a dosage interval of once weekly, biweekly, twicemonthly or once monthly.

In an embodiment of the invention, the present invention relates to amethod of inhibiting bone resorption in mammal in need thereof byadministering a cathepsin K inhibitor according to formula I or II, or apharmaceutically acceptable salt thereof, or a mixture thereof,characterized by a single-dose AUC₀₋₁₆₈ of about 2.00-80.0 μM/hr and aC_(min) of about 10 nM to about 200 nM, in an oral unit dose accordingto a continuous schedule having a dosage interval of once weekly,biweekly, twice monthly or once monthly.

In a class of the embodiment, the present invention relates to the useof an oral pharmaceutical composition comprising about 2.5 mg to about250 mg of a compound selected from the group consisting of:

-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[2′-methyl-4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-L-leucinamide;-   N²-{(1S)-1-[4′-(aminosulfonyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-[(1S)-2,2,2-trifluoro-1-(4′-fluorobiphenyl-4-yl)ethyl]-L-leucinamide;-   N²-{(1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-[(1S)-2,2,2-trifluoro-1-{4-[4-(trifluoromethyl)-1,3-thiazol-2-yl]phenyl}ethyl)-L-leucinamide;-   N²-((1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]-2′-fluorobiphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-N²-((1S)-1-{4′-[(1R)-2,2-difluoro-1-hydroxyethyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-N²-[(1S)-1-{4′-[(1S)-2,2-difluoro-1-hydroxyethyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{4-[5-methyl-6-(methylsulfonyl)pyridin-3-yl]phenyl}ethyl)-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-N²-{(1S)-1-[4′-(1-cyanocyclopropyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-4-fluoro-L-leucinamide;-   N²-[(1S)-1-(4-{5-[1-(aminocarbonyl)cyclopropyl]-3-chloropyridin-2-yl}phenyl)-2,2,2-trifluoroethyl]-N-1-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N²-[(1S)-1-(5-{4-[1-(aminocarbonyl)cyclopropyl]phenyl}pyridin-2-yl)-2,2,2-trifluoroethyl]-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{5-[4-(methylsulfonyl)phenyl]pyridin-2-yl}ethyl)-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-(1S)-2,2,2-trifluoro-1-[4′-(methylsulfinyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;-   N¹-(cyanocyclopropyl)-N²-{(1S)-2,2-difluoro-1-[4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-4-fluoro-L-leucinamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1-methyl-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-dichloro-2-[4-[4-(methylsulfonyl)phenyl]-1-methyl-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1-(2,2,2-trifluoroethyl)-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-dichloro-2-[4-[4-(methylsulfonyl)phenyl]-1-(2,2,2-trifluoroethyl)-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   and salts thereof.

In another embodiment of the invention, the present invention relates toa method of inhibiting bone resorption in a mammal in need thereof byadministering a cathepsin K inhibitor selected from the compoundsdescribed above.

In a class of the embodiment of the invention, the cathepsin K inhibitorisNI-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide.

Methods of preparation for the above compounds are described inInternational Publications WO 03/075836, which published on Sep. 18,2003 and WO 2005/000800, which published on Jan. 6, 2005.

In an embodiment of the invention, the present invention relates to theuse of an oral pharmaceutical composition comprising about 2.5 mg toabout 250 mg of a cathepsin K inhibitor and another agent selected fromthe group consisting of an organic bisphosphonate; an estrogen receptormodulator; an androgen receptor modulator; an inhibitor of osteoclastproton ATPase; an inhibitor of HMG-CoA reductase; an integrin receptorantagonist; an osteoblast anabolic agent; calcium; Vitamin D; asynthetic Vitamin D analogue; a Nonsteroidal anti-inflammatory drug; aselective cyclooxygenase-2 inhibitor; an inhibitor of interleukin-1beta; a LOX/COX inhibitor; a RANKL inhibitor; and the pharmaceuticallyacceptable salts and mixtures thereof. In a class of the embodiment, theagent is Vitamin D. In a subclass of the embodiment, the amount ofVitamin D is 2,800, IU, 5,600 IU, 7,000 IU, 8,400 IU, 11,200 IU, 14,000IU, 16,800 IU or 19,600 IU. In a further subclass of the embodiment, theamount of Vitamin D to be dosed weekly is 2,800, IU, 5,600 IU, 7,000 IU,8,400 IU or 11,200 IU. In a further subclass of the embodiment, theamount of Vitamin D to be dosed monthly is 11,200 IU, 14,000 IU, 15,400IU, 16,800 IU or 19,600 IU.

It is understood that substituents and substitution patterns on thecompounds described herein can be selected by one of ordinary skill inthe art to provide compounds that are chemically and metabolicallystable and that can be readily synthesized by techniques known in theart, as well as those methods set forth below, from readily availablestarting materials. If a substituent is itself substituted with morethan one group, it is understood that these multiple groups may be onthe same carbon or on different carbons, so long as a stable structureresults. The phrase “optionally substituted with one or moresubstituents” should be taken to be equivalent to the phrase “optionallysubstituted with at least one substituent” and in such cases thepreferred embodiment will have from zero to three substituents.

As used herein, “alkyl” is intended to include both branched andstraight-chain saturated aliphatic hydrocarbon groups having one to tencarbon atoms unless otherwise specified. For example, C₁-C₁₀, as in“C₁-C₁₀ alkyl” is defined to include groups having 1, 2, 3, 4, 5, 6, 7,8, 9 or 10 carbons in a linear, branched, or cyclic arrangement. Forexample, “C₁-C₁₀ alkyl” specifically includes methyl, ethyl, propyl,butyl, pentyl, hexyl, heptyl, octyl, nonyl, decyl, and so on.

“Alkoxy” or “alkyloxy” represents an alkyl group as defined above,unless otherwise indicated, wherein said alkyl group is attached throughan oxygen bridge. Examples of alkoxy include methoxy, ethoxy and thelike.

The term “cycloalkyl” or “carbocycle” shall mean cyclic rings of alkanesof three to eight total carbon atoms, unless otherwise indicated, or anynumber within this range (i.e., cyclopropyl, cyclobutyl, cyclopentyl,cyclohexyl, cycloheptyl or cyclooctyl).

The term “alkynyl” refers to a hydrocarbon radical straight or branched,containing from 2 to 10 carbon atoms, unless otherwise specified,containing at least 1 carbon to carbon triple bond. Up to 3carbon-carbon triple bonds may be present. Thus, “C₂-C₆ alkynyl” meansan alkynyl radical having from 2 to 6 carbon atoms. Alkynyl groupsinclude ethynyl, propynyl and butynyl. The straight, branched or cyclicportion of the alkynyl group may contain triple bonds and may besubstituted if a substituted alkynyl group is indicated.

In certain instances, substituents may be defined with a range ofcarbons that includes zero, such as (C₀-C₆)alkylene-aryl. If aryl istaken to be phenyl, this definition would include phenyl itself as wellas —CH₂Ph, —CH₂CH₂Ph, CH(CH₃)CH₂CH(CH₃)Ph, and so on.

As used herein, “aryl” is intended to mean any stable monocyclic orbicyclic carbon moiety of up to 12 atoms in each ring, wherein at leastone ring is aromatic. Examples of such aryl groups include phenyl,naphthyl, tetrahydronaphthyl, indanyl, biphenyl, phenanthryl, anthryl oracenaphthyl. A preferable example of aryl is phenyl. In cases where thearyl substituent is bicyclic and one ring is non-aromatic, it isunderstood that attachment is via the aromatic ring.

The term “heteroaryl”, as used herein, represents a stable monocyclic,bicyclic or tricyclic group of up to 10 atoms in each ring, wherein atleast one ring is aromatic and contains from 1 to 4 heteroatoms selectedfrom the group consisting of O, N and S. Heteroaryl groups within thescope of this definition include but are not limited to:benzoimidazolyl, benzofuranyl, benzofurazanyl, benzopyrazolyl,benzotriazolyl, benzothiophenyl, benzoxazolyl, carbazolyl, carbolinyl,cinnolinyl, furanyl, indolinyl, indolyl, indolazinyl, indazolyl,isobenzofuranyl, isoindolyl, isoquinolyl, isothiazolyl, isoxazolyl,naphthpyridinyl, oxadiazolyl, oxazolyl, oxazoline, isoxazoline, pyranyl,pyrazinyl, pyrazolyl, pyridazinyl, pyridopyridinyl, pyridyl,pyrimidinyl, pyrrolyl, quinazolinyl, quinolyl, quinoxalinyl, tetrazolyl,tetrazolopyridyl, thiadiazolyl, thiazolyl, thienyl, triazolyl,dihydrobenzoimidazolyl, dihydrobenzofuranyl, dihydrobenzothiophenyl,dihydrobenzoxazolyl, dihydroindolyl, dihydroquinolinyl,methylenedioxybenzene, benzothiazolyl, benzothienyl, quinolinyl,isoquinolinyl, oxazolyl, and tetra-hydroquinoline. In cases where theheteroaryl substituent is bicyclic and one ring is non-aromatic orcontains no heteroatoms, it is understood that attachment is via thearomatic ring or via the heteroatom containing ring, respectively. Ifthe heteroaryl contains nitrogen atoms, it is understood that thecorresponding N-oxides thereof are also encompassed by this definition.

As appreciated by those of skill in the art, “halo” or “halogen” as usedherein is intended to include chloro, fluoro, bromo and iodo. The term“keto” means carbonyl (C═O).

The term “haloalkyl” means an alkyl radical as defined above, unlessotherwise specified, that is substituted with one to five, preferablyone to three halogen. Representative examples include, but are notlimited to trifluoromethyl, dichloroethyl, and the like.

The term “arylalkyl” includes an alkyl portion where alkyl is as definedabove and to include an aryl portion where aryl is as defined above.Examples of arylalkyl include, but are not limited to, benzyl,fluorobenzyl, chlorobenzyl, phenylethyl, phenylpropyl,fluorophenylethyl, and chlorophenylethyl. Examples of alkylaryl include,but are not limited to, toluoyl, ethylphenyl, and propylphenyl.

The term “heteroarylalkyl” as used herein, shall refer to a system thatincludes a heteroaryl portion, where heteroaryl is as defined above, andcontains an alkyl portion. Examples of heteroarylalkyl include, but arenot limited to, thienylmethyl, thienylethyl, thienylpropyl,pyridylmethyl, pyridylethyl and imidazoylmethyl.

The term “cycloalkylalkyl” includes an alkyl portion where alkyl is asdefined above and also includes a cycloalkyl portion where cycloalkyl isas defined above. Examples of cycloalkylalkyl include, but are notlimited to, cyclopropylmethyl, cyclopentylmethyl, cyclohexylmethyl,cyclopropylethyl, and the like.

The term “heterocyclylalkyl” as used herein, shall refer to a systemthat includes a heterocyclyl portion, where heterocyclyl is as definedabove, and contains an alkyl portion. Examples of heterocyclylalkylinclude, but are not limited to, oxiranyl, azetidinyl, pyrrolidinyl,piperidinyl, piperazinyl, and morpholinyl.

The term “heterocycle” or “heterocyclyl” as used herein is intended tomean a 5- to 10-membered nonaromatic ring, unless otherwise specified,containing from 1 to 4 heteroatoms selected from the group consisting ofO, N, S, SO, or SO₂ and includes bicyclic groups. “Heterocyclyl”therefore includes, but is not limited to the following: piperazinyl,piperidinyl, pyrrolidinyl, morpholinyl, thiomorpholinyl,tetrahydropyranyl, dihydropiperidinyl, tetrahydrothiophenyl and thelike. If the heterocycle contains a nitrogen, it is understood that thecorresponding N-oxides thereof are also emcompassed by this definition.

The cathepsin K inhibitors described herein also include N-oxidederivatives and protected derivatives of compounds of Formula I. Forexample, when compounds of Formula I contain an oxidizable nitrogenatom, the nitrogen atom can be converted to an N-oxide by methods wellknown in the art. Also when compounds of Formula I contain groups suchas hydroxy, carboxy, thiol or any group containing a nitrogen atom(s),these groups can be protected with a suitable protecting groups. Acomprehensive list of suitable protective groups can be found in T. W.Greene, Protective Groups in Organic Synthesis, John Wiley & Sons, Inc.1981, the disclosure of which is incorporated herein by reference in itsentirety.

Whenever the term “alkyl” or “aryl” or either of their prefix rootsappear in a name of a substituent (e.g., aryl C₀₋₈ alkyl) it shall beinterpreted as including those limitations given above for “alkyl” and“aryl.” Designated numbers of carbon atoms (e.g., C₁₋₁₀) shall referindependently to the number of carbon atoms in an alkyl or cyclic alkylmoiety or to the alkyl portion of a larger substituent in which alkylappears as its prefix root.

The cathepsin K inhibitors described herein can be administered in suchoral dosage forms as tablets, capsules (each of which includes sustainedrelease or timed release formulations), pills, powders, granules,liquids, elixers, suspensions, syrups and emulsions.

The dosage regimen utilizing the cathepsin K inhibitors described hereinis selected in accordance with a variety of factors including type,species, age, weight, sex and medical condition of the patient; theseverity of the condition to be treated; the route of administration;the renal and hepatic function of the patient; and the particularcompound or salt thereof employed. An ordinarily skilled physician,veterinarian or clinician can readily determine and prescribe theeffective amount of the drug required to prevent, counter or arrest theprogress of the condition.

The present invention also encompasses a pharmaceutical compositionuseful in the treatment of osteoporosis or other bone disorders,comprising the administration of a therapeutically effective amount ofthe cathepsin K inhibitors described herein, with or withoutpharmaceutically acceptable carriers or diluents. Suitable compositionsof this invention include aqueous solutions comprising compounds of thisinvention and pharmacologically acceptable carriers. An embodiment ofthe invention includes a pharmaceutical composition comprising about 2.5mg to about 200 mg of a cathepsin K inhibitor selected from

-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[2′-methyl-4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-L-leucinamide;-   N²-{(1S)-1-[4′-(aminosulfonyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-[(1S)-2,2,2-trifluoro-1-(4′-fluorobiphenyl-4-yl)ethyl]-L-leucinamide;-   N²-((1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{4-[4-(trifluoromethyl)-1,3-thiazol-2-yl]phenyl}ethyl)-L-leucinamide;-   N²-((1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]-2′-fluorobiphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-N²-((1S)-1-{4′-[(1R)-2,2-difluoro-1-hydroxyethyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-N²-((1S)-1-{4′-[(1S)-2,2-difluoro-1-hydroxyethyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{4-[5-methyl-6-(methylsulfonyl)pyridin-3-yl]phenyl}ethyl)-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-N²-{(1S)-1-[4′-(1-cyanocyclopropyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-4-fluoro-L-leucinamide;-   N²-[(1S)-1-(4-{5-[1-(aminocarbonyl)cyclopropyl]-3-chloropyridin-2-yl}phenyl)-2,2,2-trifluoroethyl]-N-1-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N²-[(1S)-1-(5-{4-[1-(aminocarbonyl)cyclopropyl]phenyl}pyridin-2-yl)-2,2,2-trifluoroethyl]-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{5-[4-(methylsulfonyl)phenyl]pyridin-2-yl}ethyl)-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfinyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;-   N¹-(1-cyanocyclopropyl)-N²-{(1S)-2,2-difluoro-1-[4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-4-fluoro-L-leucinamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1-methyl-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-dichloro-2-[4-[4-(methylsulfonyl)phenyl]-1-methyl-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1-(2,2,2-trifluoroethyl)-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   (1R,2R)—N-(1-cyanocyclopropyl)-5,5-dichloro-2-[4-[4-(methylsulfonyl)phenyl]-1-(2,2,2-trifluoroethyl)-1H-pyrazol-3-yl]cyclohexanecarboxamide;-   or a salt thereof.

In a class of the embodiment, the cathepsin K inhibitor isN¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamideor a salt thereof.

In one exemplary application, a suitable amount of compound isadministered to a mammal undergoing treatment for a cathepsin dependentcondition. Oral dosages of the present invention, when used for theindicated effects, will range between about 0.01 mg per kg of bodyweight per week (mg/kg/week) to about 10 mg/kg/week, preferably 0.1 to10 mg/kg/week, and most preferably 0.1 to 5.0 mg/kg/week. For oraladministration, the compositions are preferably provided in the form oftablets containing 2.5 mg, 3.5 mg, 5 mg, 10 mg, 20 mg, 25 mg, 35 mg, 40mg, 50 mg, 80 mg, 100 mg and 200 mg of the active ingredient for thesymptomatic adjustment of the dosage to the patient to be treated. Amedicament typically contains from about 2.5 mg to about 200 mg of theactive ingredient, specifically, 2.5 mg, 3.5 mg, 5 mg, 10 mg, 20 mg, 25mg, 35 mg, 40 mg, 50 mg, 80 mg, 100 mg and 200 mg of active ingredient.Advantageously, the cathepsin K inhibitor may be administered in asingle weekly dose. Alternatively, the cathepsin K inhibitor may beadministered in a biweekly, twice monthly or monthly dose.

The compounds of this invention may be administered to mammals,preferably humans, either alone or, preferably, in combination withpharmaceutically acceptable carriers or diluents, optionally with knownadjuvants, such as alum, in a pharmaceutical composition, according tostandard pharmaceutical practice. The compounds can be administeredorally.

In the case of tablets for oral use, carriers which are commonly usedinclude lactose and corn starch, and lubricating agents, such asmagnesium stearate, are commonly added. For oral administration incapsule form, useful diluents include lactose and dried corn starch. Fororal use of a therapeutic compound according to this invention, theselected compound may be administered, for example, in the form oftablets or capsules, or as an aqueous solution or suspension. For oraladministration in the form of a tablet or capsule, the active drugcomponent can be combined with an oral, non-toxic, pharmaceuticallyacceptable, inert carrier such as lactose, starch, sucrose, glucose,methyl cellulose, magnesium stearate, dicalcium phosphate, calciumsulfate, mannitol, sorbitol and the like; for oral administration inliquid form, the oral drug components can be combined with any oral,non-toxic, pharmaceutically acceptable inert carrier such as ethanol,glycerol, water, polyethylene glycol, and the like. Moreover, whendesired or necessary, suitable binders, lubricants, disintegratingagents and coloring agents can also be incorporated into the mixture.Suitable binders include starch, gelatin, natural sugars such as glucoseor beta-lactose, corn sweeteners, natural and synthetic gums such asacacia, tragacanth or sodium alginate, carboxymethylcellulose,polyethylene glycol, waxes and the like. Lubricants used in these dosageforms include sodium oleate, sodium stearate, magnesium stearate, sodiumbenzoate, sodium acetate, sodium chloride and the like. Disintegratorsinclude, without limitation, starch, methyl cellulose, agar, bentonite,xanthan gum and the like. When aqueous suspensions are required for oraluse, the active ingredient is combined with emulsifying and suspendingagents. If desired, certain sweetening and/or flavoring agents may beadded. For intramuscular, intraperitoneal, subcutaneous and intravenoususe, sterile solutions of the active ingredient are usually prepared,and the pH of the solutions should be suitably adjusted and buffered.For intravenous use, the total concentration of solutes should becontrolled in order to render the preparation isotonic.

The cathepsin K inhibitors described herein can also be administered inthe form of liposome delivery systems, such as small unilamellarvesicles, large unilamellar vesicles and multilamellar vesicles.Liposomes can be formed from a variety of phospholipids, such ascholesterol, stearylamine or phosphatidylcholines.

Cathepsin K inhibitors described herein may also be delivered by the useof monoclonal antibodies as individual carriers to which the compoundmolecules are coupled. The cathepsin K inhibitors described herein mayalso be coupled with soluble polymers as targetable drug carriers. Suchpolymers can include polyvinylpyrrolidone, pyran copolymer,polyhydroxypropylmethacrylamide-phenol,polyhydroxy-ethylaspartamide-phenol, or polyethyleneoxide-polylysinesubstituted with palmitoyl residues. Furthermore, the cathepsin Kinhibitors described herein may be coupled to a class of biodegradablepolymers useful in achieving controlled release of a drug, for example,polylactic acid, polyglycolic acid, copolymers of polyactic andpolyglycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid,polyorthoesters, polyacetals, polydihydropyrans, polycyanoacrylates andcrosslinked or amphipathic block copolymers of hydrogels.

The present invention also encompasses a kit adapted for a continuousdosing schedule of a cathepsin K inhibitor having a dosing periodicityof once weekly, biweekly, twice monthly or once monthly comprising anumber of unit doses of a pharmaceutical composition comprising acathepsin K inhibitor, pharmaceutically acceptable salts thereof, or amixture thereof.

In an embodiment of the invention, the cathepsin K inhibitor isN¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide.

In a further embodiment of the invention, the kit is for weeklyadministration. In a class of the invention, the unit doses comprisefrom 2.5 mg to about 200 mg of the cathepsin K inhibitor. In a subclassof the invention, the unit doses comprise 2.5 mg, 3.5 mg, 5 mg, 10 mg,20 mg, 25 mg, 35 mg, 40 mg, 50 mg, 80 mg, 100 mg or 200 mg of thecathepsin K inhibitor. In another class of the invention, the kit isadapted for twice-weekly dosing. In a class of the invention, the unitdoses comprise from 2.5 mg to 50 mg of the cathepsin K inhibitor. In asubclass of the invention, the unit doses comprise from 2.5 mg to 25 mgof the cathepsin K inhibitor. In another class of the invention, the kitis adapted for biweekly or twice-monthly dosing. In a class of theinvention, the unit doses comprise from 2.5 mg to 50 mg of the cathepsinK inhibitor. In a subclass of the invention, the unit doses comprisefrom 2.5 mg to 25 mg of the cathepsin K inhibitor.

In an embodiment of the invention, the kit is a blister pack. In a classof the invention, the kit further comprises a memory aid designating thedays in the treatment schedule in which the dosages can be administered.In a subclass of the invention, the memory aid is a calendar insert.

In an embodiment of the invention, the kit is adapted for administrationon the same day of each week. In a class of the invention, the kit isadapted for weekly administration every Sunday.

Another embodiment of the invention is a method of inhibiting bone lossin a mammal in need thereof, comprising administering to the mammal atherapeutically effective amount of any of the compounds or any of thepharmaceutical compositions described above. Another embodiment of theinvention is a method of reducing bone loss in a mammal in need thereof,comprising administering to the mammal a therapeutically effectiveamount of any of the compounds or any of the pharmaceutical compositionsdescribed above. The utility of cathepsin K inhibitors in the inhibitionof bone resorption is known in the literature, see Stroup, G B, Lark, MW, Veber, D F., Bhattacharrya, A, Blake, S, Dare, L C, Erhard, K F,Hoffman, S J, James, I E, Marquis, R W, Ru, Y, Vasko-Moser, J A, Smith,B R, Tomaszek, T and Gowen, M, “Potent and selective inhibition of humancathepsin K leads to inhibition of bone resorption in vivo in a nonhumanprimate”, J. Bone Miner. Res., 16:1739-1746; 2001; and Votta, B J, Levy,M A, Badger, A, Dodds, R A, James, I E, Thompson, S, Bossard, M J, Carr,T, Connor, J R, Tomaszek, T A, Szewczuk, L, Drake, F H, Veber, D, andGowen, M, “Peptide aldehyde inhibitors of cathepsin K inhibit boneresorption both in vivo and in vitro”, J. Bone Miner. Res. 12:1396-1406;1997.

Another embodiment of the invention is a method of treating orpreventing osteoporosis in a mammal in need thereof, comprisingadministering to the mammal a therapeutically effective amount of any ofthe compounds or any of the above pharmaceutical compositions describedabove. The utility of cathepsin K inhibitors in the treatment orprevention of osteoporosis is known in the literature, see Saftig, P,Hunziker, Wehmeyer, O, Jones, S, Boyde, A, Rommerskirch, W, Moritz, J D,Schu, P, and Vonfigura, K, “Impaired osteoclast bone resorption leads toosteopetrosis in cathepsin K-deficient mice”, Proc. Natl. Acad. Sci. USA95:13453-13458; 1998.

Another embodiment of the invention is a method of treating orpreventing rheumatoid arthritic condition in a mammal in need thereof,comprising administering to the mammal a therapeutically effectiveamount of any of the compounds or any of the pharmaceutical compositionsdescribed above. It is known in the literature that progressivedestruction of the periarticular bone is a major cause of jointdysfunction and disability in patients with rheumatoid arthritis (RA),see Goldring S R, “Pathogenesis of bone erosions in rheumatoidarthritis”, Curr. Opin. Rheumatol. 2002; 14: 406-10. Analysis of jointtissues from patients with RA have provided evidence that cathepsin Kpositive osteoclasts are the cell types that mediate the focal boneresorption associated with rheumatoid synovial lesion, see Hou, W -S,Li, W, Keyszer, G, Weber, E, Levy, R, Klein, M J, Gravallese, E M,Goldring, S R, Bromme, D, “Comparison of Cathepsin K and S expressionwithin the Rheumatoid and Osteoarthritic Synovium”, Arthritis Rheumatism2002; 46: 663-74. In addition, generalized bone loss is a major cause ofmorbidity associated with severe RA. The frequency of hip and spinalfractures is substantially increased in patients with chronic RA, seeGould A, Sambrook, P, Devlin J et al, “Osteoclastic activation is theprincipal mechanism leading to secondary osteoporosis in rheumatoidarthritis”, J. Rheumatol. 1998; 25: 1282-9. The utility of cathepsin Kinhibitors in the treatment or prevention of resorption in subarticularbone and of generalized bone loss represent a rational approach forpharmacological intervention on the progression of rheumatoid arthritis.

Another embodiment of the invention is a method of treating orpreventing the progression of osteoarthritis in a mammal in needthereof, comprising administering to the mammal a therapeuticallyeffective amount of any of the compounds or any of the pharmaceuticalcompositions described above. It is known in the literature thatosteoarthritis (OA) is accompanied with well-defined changes in thejoints, including erosion of the articular cartilage surface,peri-articular endochondral ossification/osteophytosis, and subchondralbony sclerosis and cyst formation, see Oettmeier R, Abendroth, K,“Osteoarthritis and bone: osteologic types of osteoarthritis of thehip”, Skeletal Radiol. 1989; 18: 165-74. Recently, the potentialcontribution of subchondral bone sclerosis to the initiation andprogression of OA have been suggested. Stiffened subchondral bone as thejoint responding to repetitive impulsive loading, is less able toattenuate and distribute forces through the joint, subjecting it togreater mechanical stress across the articular cartilage surface. Thisin turn accelerates cartilage wear and fibrillate, see Radin, E L andRose R M, “Role of subchondral bone in the initiation and progression ofcartilage damage”, Clin. Orthop. 1986; 213: 34-40. Inhibition ofexcessive subarticular bone resorption by an anti-resorptive agent suchas a cathepsin K inhibitor, will lead to inhibition of subchondral boneturnover, thus may have a favorable impact on OA progression.

In addition to the above hypothesis, cathepsin K protein expression wasrecently identified in synovial fibroblasts, macrophage-like cells, andchondrocytes from synovium and articular cartilage specimens derivedfrom OA patients, see Hou, W -S, Li, W, Keyszer, G, Weber, E, Levy, R,Klein, M J, Gravallese, E M, Goldring, S R, Bromme, D, “Comparison ofCathepsin K and S expression within the Rheumatoid and OsteoarthriticSynovium”, Arthritis Rheumatism 2002; 46: 663-74; and Dodd, R A, Connor,J R, Drake, F H, Gowen, M, “Expression of Cathepsin K messenger RNA ingiant cells and their precursors in human osteoarthritic synovialtissues”, Arthritis Rheumatism 1999; 42: 1588-93; and Konttinen, Y T,Mandelin, J, Li, T-F, Salo, J, Lassus, J et al., “Acidic cysteineendoproteinase cathepsin K in the degeneration of the superficialarticular hyaline cartilage in osteoarthritis”, Arthritis Rheumatism2002; 46: 953-60. These recent studies thus implicated the role ofcathepsin K in the destruction of collagen type II in the articularcartilage associated with the progression of osteoarthritis. The utilityof cathepsin K inhibitors in the treatment or prevention ofosteoarthritis as described in this invention thus comprise of twodifferent mechanisms, one is on the inhibition of osteoclast-drivensubchondral bone turnover, and two is on the direct inhibition ofcollagen type II degeneration in the synovium and cartilage of patientswith OA.

Another embodiment of the invention is a method of treating cancer in amammal in need thereof, comprising administering to the mammal atherapeutically effective amount of any of the compounds or any of thepharmaceutical compositions described above. It is known in theliterature that cathepsin K is expressed in human breast carcinoma,prostate cancer and chordoma and has matrix degrading capabilities, seeLittlewood-Evans A J, Bilbe G, Bowler W B, Farley D, Wlodarski B, KokuboT, Inaoka T, Sloane J, Evans D B, Gallagher J A, “Theosteoclast-associated protease cathepsin K is expressed in human breastcarcinoma”, Cancer Res 1997 Dec. 1; 57(23):5386-90; Brubaker K D,Vessella R L, True L D, Thomas R, Corey E “Cathepsin K mRNA and proteinexpression in prostate cancer progression”, J Bone Miner Res 2003 18,222-30; and Haeckel C, Krueger S, Kuester D, Ostertag H, Samii M,Buehling F, Broemme D, Czerniak B, Roessner A, “Expression of cathepsinK in chordoma”, Hum Pathol 2000 July; 31(7):834-40.

Another embodiment of the invention is a method of treatingatherosclerosis in a mammal in need thereof, comprising administering tothe mammal a therapeutically effective amount of any of the compounds orany of the pharmaceutical compositions described above. It is known inthe literature that cathepsin K is expressed in human atheroma and hassignificant elastase activity, see Sukhova G K, Shi G P, Simon D I,Chapman H A, Libby P, “Expression of the elastolytic cathepsins S and Kin human atheroma and regulation of their production in smooth musclecells”, J Clin Invest 1998 August 102, 576-83.

Another embodiment of the invention is a method of treating obesity andobesity related conditions in a mammal in need thereof, comprisingadministering to the mammal a therapeutically effective amount of any ofthe compounds or any of the pharmaceutical compositions described above.It is known in the literature that cathepsin K mRNA is increased inadipose tissue in several mouse models of obesity. In lean and obesemale humans, a significant correlation between cathepsin K geneexpression in adipose tissue and body mass index is observed seeChiellini C, Costa M, Novelli S E, Amri E Z, Benzi L, Bertacca A, CohenP, Del Prato S, Friedman J M, Maffei M, “Identification of cathepsin Kas a novel marker of adiposity in white adipose tissue”, Cell Physiol2003, 195, 309-21. These data show that a relationship exists betweencathepsin K and adipogenesis and obesity.

Another embodiment of the invention is a method of treating chronicobstructive pulmonary disease in a mammal in need thereof, comprisingadministering to the mammal a therapeutically effective amount of any ofthe compounds or any of the pharmaceutical compositions described above.It is known in the literature that cathepsin K plays a role in lungfibrosis, see Buhling, F, et al., “Pivotal role of cathepsin K in lungfibrosis”, Am J Pathol. 2004 June; 164(6):2203-16.

Another embodiment of the invention is a method of treating parasiticinfections in a mammal in need thereof, comprising administering to themammal a therapeutically effective amount of any of the compounds or anyof the pharmaceutical compositions described above. It is known in theliterature that mammalian cathepsins are related to the papain-likecysteine proteases which play an important role in the life cycle ofthese parasites. Such parasites are involved in the diseases of malaria,American trypanosomiasis, African trypanosomiasis, leishmaniasis,giardiasis, trichomoniasis, amoebiasis, schistosomiasis, fascioliasis,paragonimiasis and intestinal roundworms, see Lecaille F, Kaleta J,Bromme D, “Human and parasitic papain-like cysteine proteases: theirrole in physiology and pathology and recent developments in inhibitordesign”, Chem Rev 2002 102, 4459-88.

Another embodiment of the invention is a method of treating severe acuterespiratory syndrome (SARS) in a mammal in need thereof, comprisingadministering to the mammal a therapeutically effective amount of any ofthe compounds or any of the pharmaceutical compositions described above.

Another embodiment of the invention is a method of treating metastaticbone disease in a mammal in need thereof, comprising administering tothe mammal a therapeutically effective amount of any of the compounds orany of the pharmaceutical compositions described above. It is known inthe literature that osteoclasts are responsible for bone resorption andthat bone destruction and hypercalcemia induced by metastatic tumors arecarried out by osteoclasts. Accordingly, the inhibition of osteoclastscan prevent bone destruction and bone metastasis, see Miyamoto, T andSuda, T, “Differentiation and function of osteoclasts”, Keio J Med 2003March; 52(1):1-7.

Another embodiment of the invention is administering to a mammal atherapeutically effective amount of any of the compounds or any of thepharmaceutical compositions described above for the treatment ofmammalian diseases associated with cathepsin S including Alzheimer'sdisease, atherosclerosis, chronic obstructive pulmonary disease,neuropathic pain, nociceptive pain, cancer and certain autoimmunedisorders, including, but not limited to juvenile onset diabetes,multiple sclerosis, pemphigus vulgaris, Graves' disease, myastheniagravis, systemic lupus erythemotasus, rheumatoid arthritis andHashimoto's thyroiditis; allergic disorders, including, but not limitedto asthma; and allogenic immune responses, including, but not limitedto, rejection of organ transplants or tissue grafts. It is known in theliterature that cathepsin S activity is associated with the abovedisease states, see Munger J S, Haass C, Lernere C A, Shi G P, Wong W S,Teplow D B, Selkoe D J, Chapman H A, “Lysosomal processing of amyloidprecursor protein to A beta peptides: a distinct role for cathepsin S”,Biochem J 1995 311, 299-305; Sukhova G K, Zhang Y, Pan J H, Wada Y,Yamamoto T, Naito M, Kodama T, Tsimikas S, Witztum J L, Lu M L, SakaraY, Chin M T, Libby P, Shi G P, “Deficiency of cathepsin S reducesatherosclerosis in LDL receptor-deficient mice”, J Clin Invest 2003 111,897-906; Zheng T, Zhu Z, Wang Z, Horner R J, Ma B, Riese R J Jr, ChapmanH A Jr, Shapiro S D, Elias J A, “Inducible targeting of IL-13 to theadult lung causes matrix metalloproteinase- and cathepsin-dependentemphysema”, J Clin Invest 2000 106, 1081-93; Shi G P, Sukhova G K,Kuzuya M, Ye Q, Du J, Zhang Y, Pan J H, Lu M L, Cheng X W, Iguchi A,Perrey S, Lee A M, Chapman H A, Libby P, “Deficiency of the cysteineprotease cathepsin S impairs microvessel growth”, Circ Res 2003 92,493-500; and Nakagawa T Y, Brissette W H, Lira P D, Griffiths R J,Petrushova N, Stock J, McNeish J D, Eastman S E, Howard E D, Clarke S R,Rosloniec E F, Elliott E A, Rudensky A Y, “Impaired invariant chaindegradation and antigen presentation and diminished collagen-inducedarthritis in cathepsin S null mice”, Immunity 1999 10, 207-17.

Exemplifying the invention is the use of any of the compounds describedabove in the preparation of a medicament for the treatment and/orprevention of osteoporosis in a mammal in need thereof. Still furtherexemplifying the invention is the use of any of the compounds describedabove in the preparation of a medicament for the treatment and/orprevention of: bone loss, bone resorption, bone fractures, metastaticbone disease and/or disorders related to cathepsin functioning.

The cathepsin K inhibitors described herein can be used in combinationwith other agents useful for treating cathepsin-mediated conditions,including, but not limited to osteoporosis, glucocorticoid inducedosteoporosis, Paget's disease, abnormally increased bone turnover,periodontal disease, tooth loss, bone fractures, rheumatoid arthritis,osteoarthritis, periprosthetic osteolysis, osteogenesis imperfecta,obesity, atherosclerosis, chronic obstructive pulmonary disorder,hypercalcemia of malignancy or multiple myeloma. The individualcomponents of such combinations can be administered separately atdifferent times during the course of therapy or concurrently in dividedor single combination forms. The instant invention is therefore to beunderstood as embracing all such regimes of simultaneous or alternatingtreatment and the term “administering” is to be interpreted accordingly.It will be understood that the scope of combinations of the compounds ofthis invention with other agents useful for treating cathepsin-mediatedconditions includes in principle any combination with any pharmaceuticalcomposition useful for treating disorders related to estrogenfunctioning.

The scope of the invention therefore encompasses the use of thecathepsin K inhibitors described herein in combination with a secondagent selected from: an organic bisphosphonate; an estrogen receptormodulator; an androgen receptor modulator; an inhibitor of osteoclastproton ATPase; an inhibitor of HMG-CoA reductase; an integrin receptorantagonist; an osteoblast anabolic agent, such as PTH; a Nonsteroidalanti-inflammatory drug; a selective cyclooxygenase-2 inhibitor; aninhibitor of interleukin-1 beta; a LOX/COX inhibitor; a RANKL inhibitor;and the pharmaceutically acceptable salts and mixtures thereof. Thescope of the invention also encompasses a method of inhibiting boneresorption with the cathepsin K inhibitors described herein incombination with a second agent selected from: an organicbisphosphonate; an estrogen receptor modulator; an androgen receptormodulator; an inhibitor of osteoclast proton ATPase; an inhibitor ofHMG-CoA reductase; an integrin receptor antagonist; an osteoblastanabolic agent, such as PTH; a Nonsteroidal anti-inflammatory drug; aselective cyclooxygenase-2 inhibitor; an inhibitor of interleukin-1beta; a LOX/COX inhibitor; a RANKL inhibitor; and the pharmaceuticallyacceptable salts and mixtures thereof.

The instant compounds are also useful in combination with known agentsuseful for treating or preventing osteoporosis, glucocorticoid inducedosteoporosis, Paget's disease, abnormally increased bone turnover,periodontal disease, tooth loss, bone fractures, rheumatoid arthritis,osteoarthritis, periprosthetic osteolysis, osteogenesis imperfecta,atherosclerosis, obesity, chronic obstructive pulmonary disease,metastatic bone disease, hypercalcemia of malignancy or multiplemyeloma. Combinations of the presently disclosed cathepsin K inhibitorswith other agents useful for treating or preventing osteoporosis orother bone disorders are within the scope of the invention. A person ofordinary skill in the art would be able to discern which combinations ofagents would be useful based on the particular characteristics of thedrugs and the disease involved. Such agents include the following: anorganic bisphosphonate; an estrogen receptor modulator; an androgenreceptor modulator; an inhibitor of osteoclast proton ATPase; aninhibitor of HMG-CoA reductase; an integrin receptor antagonist; anosteoblast anabolic agent, such as PTH; calcium; Vitamin D or asynthetic Vitamin D analogue; a Nonsteroidal anti-inflammatory drug; aselective cyclooxygenase-2 inhibitor; an inhibitor of interleukin-1beta; a LOX/COX inhibitor; RANKL inhibitor; and the pharmaceuticallyacceptable salts and mixtures thereof. A preferred combination is acompound of the present invention and an organic bisphosphonate. Anotherpreferred combination is a compound of the present invention and anestrogen receptor modulator. Another preferred combination is a compoundof the present invention and an androgen receptor modulator. Anotherpreferred combination is a compound of the present invention and anosteoblast anabolic agent.

“Organic bisphosphonate” includes, but is not limited to, compounds ofthe chemical formula

wherein n is an integer from 0 to 7 and wherein A and X areindependently selected from the group consisting of H, OH, halogen, NH₂,SH, phenyl, C₁-C₃₀ alkyl, C₃-C₃₀ branched or cycloalkyl, bicyclic ringstructure containing two or three N, C₁-C₃₀ substituted alkyl, C₁-C₁₀alkyl substituted NH₂, C₃-C₁₀ branched or cycloalkyl substituted NH₂,C₁-C₁₀ dialkyl substituted NH₂, C₁-C₁₀ alkoxy, C₁-C₁₀ alkyl substitutedthio, thiophenyl, halophenylthio, C₁-C₁₀ alkyl substituted phenyl,pyridyl, furanyl, pyrrolidinyl, imidazolyl, imidazopyridinyl, andbenzyl, such that both A and X are not selected from H or OH when n is0; or A and X are taken together with the carbon atom or atoms to whichthey are attached to form a C₃-C₁₀ ring.

In the foregoing chemical formula, the alkyl groups can be straight,branched, or cyclic, provided sufficient atoms are selected for thechemical formula. The C₁-C₃₀ substituted alkyl can include a widevariety of substituents, nonlimiting examples which include thoseselected from the group consisting of phenyl, pyridyl, furanyl,pyrrolidinyl, imidazonyl, NH₂, C₁-C₁₀ alkyl or dialkyl substituted NH₂,OH, SH, and C₁-C₁₀ alkoxy.

The foregoing chemical formula is also intended to encompass complexcarbocyclic, aromatic and hetero atom structures for the A and/or Xsubstituents, nonlimiting examples of which include naphthyl, quinolyl,isoquinolyl, adamantyl, and chlorophenylthio.

Pharmaceutically acceptable salts and derivatives of the bisphosphonatesare also useful herein. Non-limiting examples of salts include thoseselected from the group consisting alkali metal, alkaline metal,ammonium, and mono-, di-, tri-, or tetra-C₁-C₁₀-alkyl-substitutedammonium. Preferred salts are those selected from the group consistingof sodium, potassium, calcium, magnesium, and ammonium salts. Morepreferred are sodium salts. Non-limiting examples of derivatives includethose selected from the group consisting of esters, hydrates, andamides.

It should be noted that the terms “bisphosphonate” and“bisphosphonates”, as used herein in referring to the therapeutic agentsof the present invention are meant to also encompass diphosphonates,biphosphonic acids, and diphosphonic acids, as well as salts andderivatives of these materials. The use of a specific nomenclature inreferring to the bisphosphonate or bisphosphonates is not meant to limitthe scope of the present invention, unless specifically indicated.Because of the mixed nomenclature currently in use by those of ordinaryskill in the art, reference to a specific weight or percentage of abisphosphonate compound in the present invention is on an acid activeweight basis, unless indicated otherwise herein. For example, the phrase“about 5 mg of a bone resorption inhibiting bisphosphonate selected fromthe group consisting of alendronate, pharmaceutically acceptable saltsthereof, and mixtures thereof, on an alendronic acid active weightbasis” means that the amount of the bisphosphonate compound selected iscalculated based on 5 mg of alendronic acid.

Non-limiting examples of bisphosphonates useful herein include thefollowing:

Alendronate, which is also known as alendronic acid,4-amino-1-hydroxybutylidene-1,1-bisphosphonic acid, alendronate sodiumor alendronate monosodium trihydrate,4-amino-1-hydroxybutylidene-1,1-bisphosphonic acid monosodiumtrihydrate.

Alendronate is described in U.S. Pat. No. 4,922,007, to Kieczykowski etal., issued May 1, 1990; U.S. Pat. No. 5,019,651, to Kieczykowski etal., issued May 28, 1991; U.S. Pat. No. 5,510,517, to Dauer et al.,issued Apr. 23, 1996; U.S. Pat. No. 5,648,491, to Dauer et al., issuedJul. 15, 1997, all of which are incorporated by reference herein intheir entirety.

Cycloheptylaminomethylene-1,1-bisphosphonic acid, YM 175, Yamanouchi(incadronate, formerly known as cimadronate), as described in U.S. Pat.No. 4,970,335, to Isomura et al., issued Nov. 13, 1990, which isincorporated by reference herein in its entirety.

1,1-dichloromethylene-1,1-diphosphonic acid (clodronic acid), and thedisodium salt (clodronate, Procter and Gamble), are described in BelgiumPatent 672,205 (1966) and J. Org. Chem. 32, 4111 (1967), both of whichare incorporated by reference herein in their entirety.

-   1-hydroxy-3-(1-pyrrolidinyl)-propylidene-1,1-bisphosphonic acid    (EB-1053).-   1-hydroxyethane-1,1-diphosphonic acid (etidronic acid).-   1-hydroxy-3-(N-methyl-N-pentylamino)propylidene-1,1-bisphosphonic    acid, also known as BM-210955, Boehringer-Mannheim (ibandronate), is    described in U.S. Pat. No. 4,927,814, issued May 22, 1990, which is    incorporated by reference herein in its entirety.-   1-hydroxy-2-imidazo-(1,2-a)pyridin-3-yethylidene (minodronate).-   6-amino-1-hydroxyhexylidene-1,1-bisphosphonic acid (neridronate).-   3-(dimethylamino)-1-hydroxypropylidene-1,1-bisphosphonic acid    (olpadronate).-   3-amino-1-hydroxypropylidene-1,1-bisphosphonic acid (pamidronate).-   [2-(2-pyridinyl)ethylidene]-1,1-bisphosphonic acid (piridronate) is    described in U.S. Pat. No. 4,761,406, which is incorporated by    reference in its entirety.-   1-hydroxy-2-(3-pyridinyl)-ethylidene-1,1-bisphosphonic acid    (risedronate).-   (4-chlorophenyl)thiomethane-1,1-disphosphonic acid (tiludronate) as    described in U.S. Pat. No. 4,876,248, to Breliere et al., Oct. 24,    1989, which is incorporated by reference herein in its entirety.-   1-hydroxy-2-(1H-imidazol-1-yl)ethylidene-1,1-bisphosphonic acid    (zoledronate).

Nonlimiting examples of bisphosphonates include alendronate,cimadronate, clodronate, etidronate, ibandronate, incadronate,minodronate, neridronate, olpadronate, pamidronate, piridronate,risedronate, tiludronate, and zolendronate, and pharmaceuticallyacceptable salts and esters thereof. A particularly preferredbisphosphonate is alendronate, especially a sodium, potassium, calcium,magnesium or ammonium salt of alendronic acid. Exemplifying thepreferred bisphosphonate is a sodium salt of alendronic acid, especiallya hydrated sodium salt of alendronic acid. The salt can be hydrated witha whole number of moles of water or non whole numbers of moles of water.Further exemplifying the preferred bisphosphonate is a hydrated sodiumsalt of alendronic acid, especially when the hydrated salt isalendronate monosodium trihydrate.

It is recognized that mixtures of two or more of the bisphosphonateactives can be utilized.

The precise dosage of the organic bisphosphonate will vary with thedosing schedule, the particular bisphosphonate chosen, the age, size,sex and condition of the mammal or human, the nature and severity of thedisorder to be treated, and other relevant medical and physical factors.Thus, a precise pharmaceutically effective amount cannot be specified inadvance and can be readily determined by the caregiver or clinician.Appropriate amounts can be determined by routine experimentation fromanimal models and human clinical studies. Generally, an appropriateamount of bisphosphonate is chosen to obtain a bone resorptioninhibiting effect, i.e. a bone resorption inhibiting amount of thebisphosphonate is administered. For humans, an effective oral dose ofbisphosphonate is typically from about 1.5 to about 6000 μg/kg bodyweight and preferably about 10 to about 2000 μg/kg of body weight. Foralendronate monosodium trihydrate, common human doses which areadministered are generally in the range of about 2 mg/day to about 40mg/day, preferably about 5 mg/day to about 40 mg/day. In the U.S.presently approved dosages for alendronate monosodium trihydrate are 5mg/day for preventing osteoporosis, 10 mg/day for treating osteoporosis,and 40 mg/day for treating Paget's disease.

In alternative dosing regimens, the bisphosphonate can be administeredat intervals other than daily, for example once-weekly dosing,twice-weekly dosing, biweekly dosing, and twice-monthly dosing. In aonce weekly dosing regimen, alendronate monosodium trihydrate would beadministered at dosages of 35 mg/week or 70 mg/week.

“Selective estrogen receptor modulators” refers to compounds whichinterfere or inhibit the binding of estrogen to the receptor, regardlessof mechanism. Examples of estrogen receptor modulators include, but arenot limited to, estrogen, progestogen, estradiol, droloxifene,raloxifene, lasofoxifene, TSE-424, tamoxifen, idoxifene, LY353381,LY117081, toremifene, fulvestrant,4-[7-(2,2-dimethyl-1-oxopropoxy-4-methyl-2-[4-[2-(1-piperidinyl)ethoxy]phenyl]-2H-1-benzopyran-3-yl]-phenyl-2,2-dimethylpropanoate,4,4′-dihydroxybenzophenone-2,4-dinitrophenyl-hydrazone, and SH646.

An “estrogen receptor beta modulator” is a compound that selectivelyagonizes or antagonizes estrogen receptor beta (ERβ). Agonizing ERβincreases transcription of the tryptophan hydroxylase gene (TPH, the keyenzyme in serotonin synthesis) via an ERβ mediated event. Examples ofestrogen receptor beta agonists can be found in PCT Internationalpublication WO 01/82923, which published on Nov. 8, 2001, and WO02/41835, which published on May 20, 2002, both of which are herebyincorporated by reference in their entirety.

“Androgen receptor modulators” refers to compounds which interfere orinhibit the binding of androgens to the receptor, regardless ofmechanism. Examples of androgen receptor modulators include finasterideand other 5α-reductase inhibitors, nilutamide, flutamide, bicalutamide,liarozole, and abiraterone acetate.

“An inhibitor of osteoclast proton ATPase” refers to an inhibitor of theproton ATPase, which is found on the apical membrane of the osteoclast,and has been reported to play a significant role in the bone resorptionprocess. This proton pump represents an attractive target for the designof inhibitors of bone resorption which are potentially useful for thetreatment and prevention of osteoporosis and related metabolic diseases.See Farina, C et al., “Selective inhibitors of the osteoclast vacuolarproton ATPase as novel bone antiresorptive agents”, DDT, 4: 163-172(1999), which is hereby incorporated by reference in its entirety.

“HMG-CoA reductase inhibitors” refers to inhibitors of3-hydroxy-3-methylglutaryl-CoA reductase. Compounds which haveinhibitory activity for HMG-CoA reductase can be readily identified byusing assays well-known in the art. For example, see the assaysdescribed or cited in U.S. Pat. No. 4,231,938 at col. 6, and WO 84/02131at pp. 30-33. The terms “HMG-CoA reductase inhibitor” and “inhibitor ofHMG-CoA reductase” have the same meaning when used herein.

Examples of HMG-CoA reductase inhibitors that may be used include butare not limited to lovastatin (MEVACOR®; see U.S. Pat. Nos. 4,231,938,4,294,926 and 4,319,039), simvastatin (ZOCOR®; see U.S. Pat. Nos.4,444,784, 4,820,850 and 4,916,239), pravastatin (PRAVACHOL®; see U.S.Pat. Nos. 4,346,227, 4,537,859, 4,410,629, 5,030,447 and 5,180,589),fluvastatin (LESCOL®; see U.S. Pat. Nos. 5,354,772, 4,911,165,4,929,437, 5,189,164, 5,118,853, 5,290,946 and 5,356,896), atorvastatin(LIPITOR®; see U.S. Pat. Nos. 5,273,995, 4,681,893, 5,489,691 and5,342,952) and cerivastatin (also known as rivastatin and BAYCHOL®; seeU.S. Pat. No. 5,177,080). The structural formulas of these andadditional HMG-CoA reductase inhibitors that may be used in the instantmethods are described at page 87 of M. Yalpani, “Cholesterol LoweringDrugs”, Chemistry & Industry, pp. 85-89 (5 Feb. 1996) and U.S. Pat. Nos.4,782,084 and 4,885,314. The term HMG-CoA reductase inhibitor as usedherein includes all pharmaceutically acceptable lactone and open-acidforms (i.e., where the lactone ring is opened to form the free acid) aswell as salt and ester forms of compounds which have HMG-CoA reductaseinhibitory activity, and therefore the use of such salts, esters,open-acid and lactone forms is included within the scope of thisinvention. An illustration of the lactone portion and its correspondingopen-acid form is shown below as structures I and II.

In HMG-CoA reductase inhibitors where an open-acid form can exist, saltand ester forms may preferably be formed from the open-acid, and allsuch forms are included within the meaning of the term “HMG-CoAreductase inhibitor” as used herein. Preferably, the HMG-CoA reductaseinhibitor is selected from lovastatin and simvastatin, and mostpreferably simvastatin. Herein, the term “pharmaceutically acceptablesalts” with respect to the HMG-CoA reductase inhibitor shall meannon-toxic salts of the compounds employed in this invention which aregenerally prepared by reacting the free acid with a suitable organic orinorganic base, particularly those formed from cations such as sodium,potassium, aluminum, calcium, lithium, magnesium, zinc andtetramethylammonium, as well as those salts formed from amines such asammonia, ethylenediamine, N-methylglucamine, lysine, arginine,ornithine, choline, N,N′-dibenzylethylenediamine, chloroprocaine,diethanolamine, procaine, N-benzylphenethylamine,1-p-chlorobenzyl-2-pyrrolidine-1′-yl-methylbenz-imidazole, diethylamine,piperazine, and tris(hydroxymethyl)aminomethane. Further examples ofsalt forms of HMG-CoA reductase inhibitors may include, but are notlimited to, acetate, benzenesulfonate, benzoate, bicarbonate, bisulfate,bitartrate, borate, bromide, calcium edetate, camsylate, carbonate,chloride, clavulanate, citrate, dihydrochloride, edetate, edisylate,estolate, esylate, fumarate, gluceptate, gluconate, glutamate,glycollylarsanilate, hexylresorcinate, hydrabamine, hydrobromide,hydrochloride, hydroxynapthoate, iodide, isothionate, lactate,lactobionate, laurate, malate, maleate, mandelate, mesylate,methylsulfate, mucate, napsylate, nitrate, oleate, oxalate, pamaote,palmitate, panthothenate, phosphate/diphosphate, polygalacturonate,salicylate, stearate, subacetate, succinate, tannate, tartrate,teoclate, tosylate, triethiodide, and valerate.

Ester derivatives of the described HMG-CoA reductase inhibitor compoundsmay act as prodrugs which, when absorbed into the bloodstream of awarm-blooded animal, may cleave in such a manner as to release the drugform and permit the drug to afford improved therapeutic efficacy.

As used above, “integrin receptor antagonists” refers to compounds whichselectively antagonize, inhibit or counteract binding of a physiologicalligand to the α_(v)β₃ integrin, to compounds which selectivelyantagonize, inhibit or counteract binding of a physiological ligand tothe α_(v)β₅ integrin, to compounds which antagonize, inhibit orcounteract binding of a physiological ligand to both the α_(v)β₃integrin and the α_(v)β₅ integrin, and to compounds which antagonize,inhibit or counteract the activity of the particular integrin(s)expressed on capillary endothelial cells. The term also refers toantagonists of the α_(v)β₆, α_(v)β₈, α₁β₁, α₂β₁, α₅β₁, α₆β₁ and α₆β₄integrins. The term also refers to antagonists of any combination ofα_(v)β₃, α_(v)β₅, α_(v)β₆, α_(v)β₈, α₁β₁, α₂β₁, α₅β₁, α₆β₁ and α₆β₄integrins. H. N. Lode and coworkers in PNAS USA 96: 1591-1596 (1999)have observed synergistic effects between an antiangiogenic αv integrinantagonist and a tumor-specific antibody-cytokine (interleukin-2) fusionprotein in the eradication of spontaneous tumor metastases. Theirresults suggested this combination as having potential for the treatmentof cancer and metastatic tumor growth. α_(v)β₃ integrin receptorantagonists inhibit bone resorption through a new mechanism distinctfrom that of all currently available drugs. Integrins are heterodimerictransmembrane adhesion receptors that mediate cell-cell and cell-matrixinteractions. The α and β integrin subunits interact non-covalently andbind extracellular matrix ligands in a divalent cation-dependent manner.The most abundant integrin on osteoclasts is α_(v)β₃ (>10⁷/osteoclast),which appears to play a rate-limiting role in cytoskeletal organizationimportant for cell migration and polarization. The α_(v)β₃ antagonizingeffect is selected from inhibition of bone resorption, inhibition ofrestenosis, inhibition of macular degeneration, inhibition of arthritis,and inhibition of cancer and metastatic growth.

“An osteoblast anabolic agent” refers to agents that build bone, such asPTH. The intermittent administration of parathyroid hormone (PTH) or itsamino-terminal fragments and analogues have been shown to prevent,arrest, partially reverse bone loss and stimulate bone formation inanimals and humans. For a discussion refer to Dempster, D W et al.,“Anabolic actions of parathyroid hormone on bone”, Endocr Rev 14:690-709 (1993). Studies have demonstrated the clinical benefits ofparathyroid hormone in stimulating bone formation and thereby increasingbone mass and strength. Results were reported by Neer, R M et al., NewEng J Med 344 1434-1441 (2001).

In addition, parathyroid hormone-related protein fragments or analogues,such as PTHrP-(1-36) have demonstrated potent anticalciuric effects [seeSyed M A et al., “Parathyroid hormone-related protein-(1-36) stimulatesrenal tubular calcium re-absorption in normal human volunteers:implications for the pathogenesis of humoral hypercalcemia ofmalignancy”, JCEM 86: 1525-1531 (2001)] and may also have potential asanabolic agents for treating osteoporosis.

“Vitamin D” includes, but is not limited to, vitamin D₃(cholecalciferol) and vitamin D₂ (ergocalciferol), which are naturallyoccurring, biologically inactive precursors of the hydroxylatedbiologically active metabolites of vitamin D: 1α-hydroxy vitamin D;25-hydroxy vitamin D, and 1α,25-dihydroxy vitamin D. Vitamin D₂ andvitamin D₃ have the same biological efficacy in humans. When eithervitamin D₂ or D₃ enters the circulation, it is hydroxylated bycytochrome P₄₅₀-vitamin D-25-hydroxylase to give 25-hydroxy vitamin D.The 25-hydroxy vitamin D metabolite is biologically inert and is furtherhydroxylated in the kidney by cytochrome P450-monooxygenase, 25 (OH)D-1α-hydroxylase to give 1,25-dihydroxy vitamin D. When serum calciumdecreases, there is an increase in the production of parathyroid hormone(PTH), which regulates calcium homeostasis and increases plasma calciumlevels by increasing the conversion of 25-hydroxy vitamin D to1,25-dihydroxy vitamin D.

1,25-dihydroxy vitamin D is thought to be responsible for the effects ofvitamin D on calcium and bone metabolism. The 1,25-dihydroxy metaboliteis the active hormone required to maintain calcium absorption andskeletal integrity. Calcium homeostasis is maintained by 1,25 dihydroxyvitamin D by inducing monocytic stem cells to differentiate intoosteoclasts and by maintaining calcium in the normal range, whichresults in bone mineralization by the deposition of calciumhydroxyapatite onto the bone surface, see Holick, M F, “Vitamin Dphotobiology, metabolism, and clinical applications”, In: DeGroot L,Besser H, Burger H G, et al., eds. Endocrinology, 3^(rd) ed., 990-1013(1995). However, elevated levels of 1α25-dihydroxy vitamin D₃ can resultin an increase of calcium concentration in the blood and in the abnormalcontrol of calcium concentration by bone metabolism, resulting inhypercalcemia. 1α,25-dihydroxy vitamin D₃ also indirectly regulatesosteoclastic activity in bone metabolism and elevated levels may beexpected to increase excessive bone resorption in osteoporosis.

In embodiments of the present invention, an appropriate amount of thevitamin D compound is chosen to provide adequate vitamin D nutritionduring the dosing interval without interfering with the cathepsin Kinhibitor's ability to obtain a bone resorption inhibiting effect. Fororal compositions of the present invention comprising a cathepsin Kinhibitor, and a vitamin D compound, an amount of the vitamin D compoundcomprises from about 100 IU to about 60,000 IU. Non-limiting examples ofan oral amount of the vitamin D compound in embodiments of the presentinvention include, but are not limited to, dosages of 2,800, IU, 5,600IU, 7,000 IU, 8,400 IU, 11,200 IU, 14,000 IU, 16,800 IU or 19,600 IU.Non-limiting examples of an oral amount of vitamin D for weekly dosingare 2,800, IU, 5,600 IU, 7,000 IU, 8,400 IU and 11,200 IU. Non-limitingexamples of an oral amount of vitamin D for monthly dosing are 11,200IU, 14,000 IU, 15,400 IU, 16,800 IU and 19,600 IU.

“Synthetic vitamin D analogues” includes non-naturally occurringcompounds that act like vitamin D.

“Calcium” includes, but is not limited to, calcium carbonate, calciumcitrate or any other compound containing elemental calcium. Calcium isessential to human health and is required for the structural integrityof the skeleton. The ionized fraction of blood calcium isphysiologicially important and is tightly maintained by both parathyroidhormone (PTH) and 1,25 dihydroxy Vitamin D. As such, decreases in bloodcalcium (or the mere insufficiency of dietary calcium) can readilyaffect PTH and 1,25 dihydroxy Vitamin D levels in such as way as toadversely affect skeletal health. Provision of supplemental calciumconsequently tends to lower PTH levels, to diminish the removal ofcalcium from skeletal stores and, in so doing, to benefit skeletalhealth. Non-limiting examples of an oral amount of the calcium inembodiments of the present invention include, but are not limited to,dosages of 1200-1500 mgs of elemental calcium per day in divided doses.

“Nonsteroidal anti-inflammatory drugs” or NSAIDs, inhibit the metabolismof arachidonic acid to proinflammatory prostaglandins via cyclooxygenase(COX)-1 and COX-2. Nonlimiting examples of NSAIDs include: aspirin,ibuprofen, naproxen, diclofenac, etodolac, fenoporfen, flubiprofen,indomethacin, ketoprofen, ketorolac, meloxicam, nabumetone, oxaprozin,piroxicam, sulindac, tolmetin, diflunisal, meclofenamate andphenylbutazone.

A “selective cyclooxygenase-2 inhibitor,” or COX-2 inhibitor, refers toa type of nonsteroidal anti-inflammatory drug (NSAID), that inhibit theCOX-2 coenzyme, which contributes to pain and inflammation in the body.Nonlimiting examples of COX-2 inhibitors include: celecoxib, etoricoxib,parecoxib, rofecoxib, valdecoxib and lumiracoxib.

An “inhibitor of interleukin-1 beta” or IL-1β refers to in inhibitors ofIL-1, which is a soluble factor produced by monocytes, macrophages, andother cells which activates T-lymphocytes and potentiates their responseto mitogens or antigens. Nonlimiting examples of IL-1B inhibitorsinclude diacerein and rhein.

A “LOX/COX inhibitor” refers to an inhibitor or all three of the majorenzymes involved in arachidonic acid pathway—namely, 5-LOX, COX-1 andCOX-2. A nonlimiting example of a LOX/COX inhibitor is licofelone.

A “RANKL inhibitor” refers to an inhibitor of receptor activator NF-kBligand (RANKL), which has previously been called osteoclastdifferentiation factor (ODF), osteoprotegerin ligand (OPGL) andTNF-related activation induced cytokine (TRANCE). RANKL is a keystimulator of osteoclast formation and maturation. A nonlimiting exampleor a RANKL inhibitor is AMG-162.

If formulated as a fixed dose, such combination products employ thecompounds of this invention within the dosage range described below andthe other pharmaceutically active agent(s) within its approved dosagerange. Compounds of the instant invention may alternatively be usedsequentially with known pharmaceutically acceptable agent(s) when acombination formulation is inappropriate.

The term “AUC” or “Area Under the Curve” refers to the area defined bythe plasma concentration-time curve over a given time period andrepresents the total exposure of the plasma to drug over a given timeperiod. AUC₀₋₂₄ refers to the area under the concentration-time curvefor the first 24 hours following administration of a compound. AUC₀₋₁₆₈refers to the area under the concentration-time curve for the first 168hours (one week) following administration of a drug.

The term “C_(min)” refers to the lowest concentration of drugcirculating in plasma over a given time period. The time of minimalconcentration is generally immediately prior to the administration ofanother dosage of the drug.

The terms “once weekly” and “once-weekly dosing,” as used herein, meansthat a unit dosage, for example a unit dosage of a cathepsin Kinhibitor, is administered once a week, i.e., once during a seven-dayperiod, preferably on the same day of each week. In the once-weeklydosing regimen, the unit dosage is generally administered about everyseven days. A non-limiting example of a once-weekly dosing regimen wouldentail the administration of a unit dosage of the cathepsin K inhibitorevery Sunday. It is customarily recommended that a unit dosage foronce-weekly administration is not administered on consecutive days, butthe once-weekly dosing regimen can include a dosing regimen in whichunit dosages are administered on two consecutive days falling within twodifferent weekly periods.

By “biweekly” dosing is meant that a unit dosage of the cathepsin Kinhibitor is administered once during a two week period, i.e. one timeduring a fourteen day period, preferably on the same day during each twoweek period. In the twice-weekly dosing regimen, each unit dosage isgenerally administered about every fourteen days. A nonlimiting exampleof a biweekly dosing regimen would entail the administration of a unitdosage of the cathepsin K inhibitor every other Sunday. It is preferredthat the unit dosage is not administered on consecutive days, but thebiweekly dosing regimen can include a dosing regimen in which the unitdosage is administered on two consecutive days within two differentbiweekly periods.

By “twice monthly” dosing is meant that a unit dosage of the cathepsin Kinhibitor is administered twice, i.e. two times, during a monthlycalendar period. With the twice monthly regimen, the doses arepreferably given on the same two dates of each month. In the twicemonthly dosing regimen, each unit dosage is generally administered aboutevery fourteen to sixteen days. A nonlimiting example of a twice monthlydosing regimen would entail dosing on or about the first of the monthand on or about the fifteenth, i.e. the midway point, of the month. Itis preferred that the unit dosages are not administered on the same orconsecutive days but the twice-monthly dosing regimen can include adosing regimen in which the unit dosages are administered on twoconsecutive days within a monthly period, or different monthly periods.The twice monthly regimen is defined herein as being distinct from, andnot encompassing, the biweekly dosing regimen because the two regimenshave a different periodicity and result in the administration ofdifferent numbers of dosages over long periods of time. For example,over a one year period, a total of about twenty four dosages would beadministered according to the twice monthly regimen (because there aretwelve calendar months in a year), whereas a total of about twenty sixdosages would be administered according to the biweekly dosing regimen(because there are about fifty-two weeks in a year).

The term “once monthly” is used in accordance with the generallyaccepted meaning as a measure of time amounting to approximately fourweeks, approximately 30 days or 1/12 of a calendar year.

The term, “upper gastrointestinal disorders” refers to disordersassociated with the upper gastrointestinal (GI) tract, including, butnot limited to, gastrointestinal reflux disease (GERD), esophagitis,dyspepsia (heartburn) and ulcers.

The term “administration” and variants thereof (e.g., “administering” acompound) in reference to a compound of the invention means introducingthe compound or a prodrug of the compound into the system of the animalin need of treatment. When a compound of the invention or prodrugthereof is provided in combination with one or more other active agents(e.g., a cytotoxic agent, etc.), “administration” and its variants areeach understood to include concurrent and sequential introduction of thecompound or prodrug thereof and other agents. The present inventionincludes within its scope prodrugs of the compounds of this invention.In general, such prodrugs will be functional derivatives of thecompounds of this invention which are readily convertible in vivo intothe required compound. Thus, in the methods of treatment of the presentinvention, the term “administering” shall encompass the treatment of thevarious conditions described with the compound specifically disclosed orwith a compound which may not be specifically disclosed, but whichconverts to the specified compound in vivo after administration to thepatient. Conventional procedures for the selection and preparation ofsuitable prodrug derivatives are described, for example, in “Design ofProdrugs,” ed. Bundgaard, H, Elsevier, 1985, which is incorporated byreference herein in its entirety. Metabolites of these compounds includeactive species produced upon introduction of compounds of this inventioninto the biological milieu.

As used herein, the term “composition” is intended to encompass aproduct comprising the specified ingredients in the specified amounts,as well as any product which results, directly or indirectly, fromcombination of the specified ingredients in the specified amounts.

The term “unit dose” as used herein describes a single unitary dose thatis administered entirely at one time.

The term “therapeutically effective amount” as used herein means thatamount of active compound or pharmaceutical agent that elicits thebiological or medicinal response in a tissue, system, animal or humanthat is being sought by a researcher, veterinarian, medical doctor orother clinician.

The terms “treating” or “treatment” of a disease as used hereinincludes: preventing the disease, i.e. causing the clinical symptoms ofthe disease not to develop in a mammal that may be exposed to orpredisposed to the disease but does not yet experience or displaysymptoms of the disease; inhibiting the disease, i.e., arresting orreducing the development of the disease or its clinical symptoms; orrelieving the disease, i.e., causing regression of the disease or itsclinical symptoms.

The term “bone resorption,” as used herein, refers to the process bywhich osteoclasts degrade bone.

These and other aspects of the invention will be apparent from theteachings contained herein.

The following examples are given for the purpose of illustrating thepresent invention and shall not be construed as limitations on the scopeof the invention.

Pharmaceutical Compositions

For the following pharmaceutical compositions,N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl})-L-leucinamidecan be used as an example of a cathepsin K inhibitor.

Composition 1

Ingredient Percentage in Tablet Cathepsin K inhibitor 0.5-25%  Lactose30-50% Microcrystalline Cellulose 30-50% Crosscamellose Sodium 3-5%Hydroxypropyl Cellose 2-4% Magnesium Stearate 0.3-0.7%

Composition 2

Ingredient Percentage in Tablet Cathepsin K inhibitor 0.5-25%  Lactose20-60% Microcrystalline Cellulose 20-60% Crosscamellose Sodium 2-6%Hydroxypropyl Cellose 1-5% Magnesium Stearate 0.2-0.8%

Composition 3

Ingredient Percentage in Tablet Cathepsin K inhibitor 0.1-40%  Lactose10-70% Microcrystalline Cellulose 10-70% Crosscamellose Sodium 1-7%Hydroxypropyl Cellose 1-6% Magnesium Stearate 0.1-1%  

Composition 4

Ingredient Percentage in Tablet Cathepsin K inhibitor  0.5-25% Lactose33.55-45.8% Microcrystalline Cellulose 33.55-45.8% Crosscamellose Sodium4.0% Hydroxypropyl Cellose 3.0% Magnesium Stearate 0.5%

1. A method of inhibiting bone resorption in a mammal in need thereofcomprising administering to the mammal a therapeutically effectiveamount of a cathepsin K inhibitor, or a pharmaceutically acceptable saltthereof, or a mixture thereof, characterized by a single-dose AUC₀₋₁₆₈of about 2.00-80.0 μM/hr and a C_(min) of about 10 nM to about 200 nM,as an oral unit dose according to a once weekly, biweekly, twice monthlyor once monthly dosing regimen.
 2. A method of inhibiting boneresorption in a mammal in need thereof comprising administering to themammal about 2.5 mg to about 200 mg of a cathepsin K inhibitor accordingto Formula I:

wherein R¹ is C₁₋₃ alkyl which is substituted with two to seven halo; R²is hydrogen or halo; X is N or CH; D is aryl or heteroaryl, wherein eachsaid aryl or heteroaryl group, which may be monocyclic or bicyclic, isoptionally substituted on either the carbon or the heteroatom with oneto four substituents independently selected from methyl, C₁₋₆ haloalkyl,halo or —SO₂R⁴; R³ is hydrogen, C₁₋₆ alkyl, C₂₋₆ alkynyl, halo, cyano,aryl, heteroaryl, C₃₋₈ cycloalkyl, heterocyclyl, —OR⁴, —C(O)N(R⁵)(R⁶),—C(R⁵)(R⁶)OH, —C(R⁵)(R⁶)N(R⁴)₂, —SO_(m)R⁴, —SO₂N(R⁴)(R⁵), or—SO₂N(R⁵)C(O)(R⁷); wherein said alkyl, alkynyl, aryl, heteroaryl,cycloalkyl and heterocyclyl groups are optionally substituted on eitherthe carbon or the heteroatom with one to five substituents independentlyselected from C₁₋₆ alkyl or halo; R⁴ is hydrogen, C₁₋₆ alkyl, aryl,aryl(C₁₋₄)alkyl, heteroaryl, heteroaryl(C₁₋₄)alkyl, C₃₋₈ cycloalkyl,C₃₋₈ cycloalkyl(C₁₋₄)alkyl, or heterocyclyl(C₁₋₄)alkyl; which areoptionally substituted with one, two, or three substituentsindependently selected from halo, alkoxy or —SO₂R⁷; R⁵ is hydrogen, C₁₋₆alkyl, or C₁₋₆ haloalkyl; R⁶ is hydrogen, C₁₋₆ alkyl, or C₁₋₆ haloalkyl;Or R⁵ and R⁶ can be taken together with the carbon or nitrogen atombetween them to form a 3 to 6 membered ring; R⁷ is hydrogen or C₁₋₆alkyl which is optionally substituted with one, two, or threesubstituents independently selected from halo or cyano; m is an integerfrom zero to two; or a salt, stereoisomer, N-oxide derivative, or amixture thereof, as an oral unit dose according to a once weekly,biweekly, twice monthly or once monthly dosing regimen.
 3. The methodaccording to claim 2 wherein the cathepsin K inhibitor isN¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[2′-methyl-4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-L-leucinamide;N²-{(1S)-1-[4′-(aminosulfonyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-[(1S)-2,2,2-trifluoro-1-(4′-fluorobiphenyl-4-yl)ethyl]-L-leucinamide;N²-((1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{4-[4-(trifluoromethyl)-1,3-thiazol-2-yl]phenyl}ethyl)-L-leucinamide;N²-((1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]-2′-fluorobiphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-N²-((1S)-1-{4′-[(1R)-2,2-difluoro-1-hydroxyethyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{4-[5-methyl-6-(methylsulfonyl)pyridin-3-yl]phenyl}ethyl)-L-leucinamide;N¹-(1-cyanocyclopropyl)-N²-{(1S)-1-[4′-(1-cyanocyclopropyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-4-fluoro-L-leucinamide;N²-[(1S)-1-(4-{5-[1-(aminocarbonyl)cyclopropyl]-3-chloropyridin-2-yl}phenyl)-2,2,2-trifluoroethyl]-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N²-[(1S)-1-(5-{4-[1-(aminocarbonyl)cyclopropyl]phenyl}pyridin-2-yl)-2,2,2-trifluoroethyl]-N-1-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{5-[4-(methylsulfonyl)phenyl]pyridin-2-yl}ethyl)-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfinyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;N¹-(1-cyanocyclopropyl)-N²-{(1S)-2,2-difluoro-1-[4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-4-fluoro-L-leucinamide;or a salt thereof.
 4. The method according to claim 3 wherein thecathepsin K inhibitor isN¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide.5. The method according to claim 4 further comprising an agent selectedfrom the group consisting of an organic bisphosphonate; an estrogenreceptor modulator; an androgen receptor modulator; an inhibitor ofosteoclast proton ATPase; an inhibitor of HMG-CoA reductase; an integrinreceptor antagonist; an osteoblast anabolic agent; calcium; Vitamin D; asynthetic Vitamin D analogue; a Nonsteroidal anti-inflammatory drug; aselective cyclooxygenase-2 inhibitor; an inhibitor of interleukin-1beta; a LOX/COX inhibitor; a RANKL inhibitor; and the pharmaceuticallyacceptable salts and mixtures thereof.
 6. The method according to claim5 wherein the agent is Vitamin D.
 7. The method according to claim 6wherein the amount of Vitamin D is 2,400 IU, 5,600 IU, 7,000 IU, 8,400IU, 11,200 IU, 14,000 IU, 15,400 IU, 16,800 IU or 19,600 IU.
 8. Themethod according to claim 2 where the oral unit dose is a tablet.
 9. Themethod according to claim 2 where the oral unit dose is a capsule. 10.The method according to claim 2 where the oral unit dose is a liquid.11. The method according to claim 4 where the mammal is identified assuffering from or susceptible to upper gastrointestinal disorders. 12.The method according to claim 11 wherein the upper gastrointestinaldisorder is gastrointestinal reflux disease, esophagitis, dyspepsia orulcers.
 13. The method according to claim 2 for treating osteoporosis.14. A pharmaceutical composition comprising about 2.5 mg to about 200 mgof a cathepsin K inhibitor selected fromN¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[2′-methyl-4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-L-leucinamide;N²-{(1S)-1-[4′-(aminosulfonyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-[(1S)-2,2,2-trifluoro-1-(4′-fluorobiphenyl-4-yl)ethyl]-L-leucinamide;N²-((1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{4-[4-(trifluoromethyl)-1,3-thiazol-2-yl]phenyl}ethyl)-L-leucinamide;N²-((1S)-1-{4′-[1-(aminocarbonyl)cyclopropyl]-2′-fluorobiphenyl-4-yl}-2,2,2-trifluoroethyl)-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-N²-((1S)-1-{4′-[(1R)-2,2-difluoro-1-hydroxyethyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-N²-((1S)-1-{4′-[(1S)-2,2-difluoro-1-hydroxyethyl]biphenyl-4-yl}-2,2,2-trifluoroethyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{4-[5-methyl-6-(methylsulfonyl)pyridin-3-yl]phenyl}ethyl)-L-leucinamide;N¹-(1-cyanocyclopropyl)-N²-{(1S)-1-[4′-(1-cyanocyclopropyl)biphenyl-4-yl]-2,2,2-trifluoroethyl}-4-fluoro-L-leucinamide;N²-[(1S)-1-(4-{5-[1-(aminocarbonyl)cyclopropyl]-3-chloropyridin-2-yl}phenyl)-2,2,2-trifluoroethyl]-N¹-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N²-[(1S)-1-(5-{4-[1-(aminocarbonyl)cyclopropyl]phenyl}pyridin-2-yl)-2,2,2-trifluoroethyl]-N-1-(1-cyanocyclopropyl)-4-fluoro-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-((1S)-2,2,2-trifluoro-1-{5-[4-(methylsulfonyl)phenyl]pyridin-2-yl}ethyl)-L-leucinamide;N¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfinyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide;N¹-(1-cyanocyclopropyl)-N²-{(1S)-2,2-difluoro-1-[4′-(methylsulfonyl)biphenyl-4-yl]ethyl}-4-fluoro-L-leucinamide;(1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1H-pyrazol-3-yl]cyclohexanecarboxamide;(1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1-methyl-1H-pyrazol-3-yl]cyclohexanecarboxamide;(1R,2R)—N-(1-cyanocyclopropyl)-5,5-dichloro-2-[4-[4-(methylsulfonyl)phenyl]-1-methyl-1H-pyrazol-3-yl]cyclohexanecarboxamide;(1R,2R)—N-(1-cyanocyclopropyl)-5,5-difluoro-2-[4-[4-(methylsulfonyl)phenyl]-1-(2,2,2-trifluoroethyl)-1H-pyrazol-3-yl]cyclohexanecarboxamide;(1R,2R)—N-(1-cyanocyclopropyl)-5,5-dichloro-2-[4-[4-(methylsulfonyl)phenyl]-1-(2,2,2-trifluoroethyl)-1H-pyrazol-3-yl]cyclohexanecarboxamide;or a salt thereof.
 15. The pharmaceutical composition according to claim14 wherein the cathepsin K inhibitor isN¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamideor a salt thereof.
 16. The composition according to claim 15 which isoral.
 17. The composition according to claim 16 which is a unit dose.18. The composition according to claim 17 which is a weekly dose. 19.The composition according to claim 18 wherein the cathepsin-K inhibitorisN¹-(1-cyanocyclopropyl)-4-fluoro-N²-{(1S)-2,2,2-trifluoro-1-[4′-(methylsulfonyl)-1,1′-biphenyl-4-yl]ethyl}-L-leucinamide.20. The composition according to claim 19 which is a tablet.
 21. Thecomposition according to claim 19 which is a capsule.
 22. Thecomposition according to claim 19 which is a powder.
 23. The compositionaccording to claim 19 which is a liquid. 24-42. (canceled)